indicated?
How should a dietary trial should be performed?
When is intestinal biopsy indicated in cases of chronic diarrhoea?
Case example
‘Colin’ is a 10‐month‐old male neutered British shorthair cat. He presents with a 3‐month history of waxing and waning diarrhoea. He is otherwise lively and well, and his appetite is normal. Vomiting has not been observed. Diarrhoea is semi‐formed to liquid, passed frequently in small volumes, sometimes with tenesmus. Mucus and blood are occasionally seen.
Colin is an indoor‐only cat and is up to date with routine vaccinations and parasite control. He is fed a commercial balanced diet suitable for his age. He was rehomed from a multi‐cat household, and his previous owner reported that some of the other cats had suffered with diarrhoea in the past.
Physical examination is unremarkable. Colin is in good body condition and palpation of his abdomen is normal.
Define the problem
Colin has semi‐formed to liquid faeces passed in small volumes, frequently. This is compatible with diarrhoea, and this cannot be easily confused with anything else.
Define the location
When the problem is diarrhoea, we define the location first, as this helps us to confirm the affected body system. Colin has semi‐formed to liquid faeces, increased frequency of defaecation, small faecal volume, tenesmus, mucus and blood. These are all seen with large bowel diarrhoea.
Define the system
Colin has large bowel diarrhoea with no signs of small bowel diarrhoea (e.g. weight loss, appetite changes). It is therefore very likely that Colin has a primary GI cause of his diarrhoea.
Define the lesion
Large bowel diarrhoea in young cats is most commonly caused by parasitic or protozoal infection. Feline infectious peritonitis and food‐responsive enteropathy are other possible differentials in this age group. Neoplasia is less likely, although lymphoma can sometimes affect cats under a year of age.
Case outcome
Colin’s diarrhoea did not improve during a properly performed diet trial of a ‘novel’ protein‐source diet. His owners had a limited budget and were keen to perform a step‐by‐step investigation of his diarrhoea. Faecal testing was performed initially due to the increased chance of infectious diarrhoea at his age and also with the knowledge that he was originally from a multi‐cat household where other cats have had diarrhoea in the past.
Faecal parasitology, Zn sulphate flotation for Giardia cysts and Tritrichomonas PCR were performed. Only the Tritrichomonas PCR was positive.
Treatment was discussed with Colin’s owners. Some cats with Tritrichomonas infection do not require treatment if their diarrhoea is relatively mild as the disease usually resolves over time. However, resolution may take many months, and cats may continue to excrete the organism even once diarrhoea has resolved. Colin’s owners were keen to treat him, and he was given ronidazole at a dose of 25 mg/kg once daily for 2 weeks. His diarrhoea resolved and did not recur.
Ronidazole should be used with caution and with informed owner consent as it may cause neurological and GI side effects. It is not licensed in most small animal markets and may not be readily available in formulations suitable for cats without the use of a licensed compounding pharmacy.
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